骨質疏鬆症性骨折之預防篩檢

Preventive Screening of Osteoporotic Fracture

李欣岱(Hsin-Dai Lee) ； 蘇千田(Chien-Tien Su) ； 林茂榮(Mau-Roung Lin)

《台灣老年醫學暨老年學雜誌》 3卷2期 (2008/05) Pp. 64-77

https://doi.org/10.29461/TGG.200805.0001

摘要

隨著老年人口的增加，骨質疏鬆症成為重要的醫學及公共衛生議題。骨質疏鬆症性骨折會造成失能、死亡、以及巨大社會成本。雖然骨質疏鬆症是臨床上重要的議題，但具脆弱性骨折病史的高危險族群中，約只有小於1/3接受適當的診斷與治療。骨質疏鬆症危險因子使用方便、成本低廉且可增加骨礦物質密度預測髖骨骨折的效力，具有大量幫助篩檢骨質疏鬆症的潛力。骨礦物質密度反映骨骼強度，而骨測量儀如雙能量X光吸收儀、定量式超音波檢查儀、及定量式電腦斷層等可以量化骨礦物質密度與偵測骨質疏鬆症。世界衛生組織使用臨床危險因子及股骨頸骨礦物質密度發展出可預測10年內髖部及其他重要骨質疏鬆症性骨折發生的風險測量工具FRAX(上標 TM)，此工具反應個人骨折風險，能幫助找出可受益於治療的低骨量及具骨折共病狀態的骨折高風險族群。骨生化指標比骨礦物質密度能更早反映骨代謝變化，也許可幫助骨折風險評估。上述篩檢工具可幫助骨質疏鬆症高危險族群早期治療來避免骨折，但對一般族群做廣泛性篩檢之效益仍未有足夠實證；台灣骨質疏鬆症篩檢之準則亦待更多研究進一步瞭解。

關鍵字

骨質疏鬆症 ； 篩檢 ； 骨折

並列摘要

Osteoporosis becomes an important medical and public health issue as the population gets older. Fragility fractures caused by osteoporosis can lead to long-term disability and deaths as well as enormous social costs. Although prevention and treatment of osteoporosis are clinically important, only one-third of high-risk fracture patients receive adequate diagnosis and treatment. Osteoporosis risk factor assessment is free, convenient and capable of enhancing the performance of bone mineral density (BMD) in perdicting hip fractures; its use in screening osteoporosis is promising. Densitometry such as Dual-energy X-ray absorptiometry, quantitative ultrasonography, and quantitative computed tomography have been developed to quantify BMD that reflects bone strength and to detect osteoporosis. The World Health Organization has introduced the FRAX(superscript TM) tool that integrates clinical risk factors as well as femoral BMD to calculate 10-year probability of a hip and of any major osteoporosis-related fractures. FRAX(superscript TM) can help target persons with low bone mass or co-morbid conditions that increase fracture risks for intervention. Biochemical indices detect bone turnover earlier than BMD and may help in the assessment of fracture risk. Screening in high-risk group can benefit from the above-listed tools and guidelines, but studies on the effectiveness of osteoporosis screening in general population remain limited. Further investigations should be performed to develop the local screening guideline in Taiwan.

並列關鍵字

osteoporosis ； screening ； fracture prevention